The president of the Catholic Medical Association, Dr Clare Walker believes that euthanasia is being quite widely practiced in the NHS in an unofficial way.

Dr Walker explained how she is regularly contacted by distressed healthcare professionals and managers who describe their experience of witnessing repeated instances of unofficial, active euthanasia in their local areas. "The standards of medical ethics and of interpretation of existing legislation appear to vary greatly around the country and from one organisation to the next, even in the same local area," said Dr Walker.

One development that has enabled this to happen is the adoption of the Liverpool Care Pathway (LCP). The LCP was developed in Liverpool in the 1990s as a result of collaboration between the Royal Liverpool Hospital and the Marie Curie hospice. The laudable aim was to bring hospice style palliative care for those living out their last hours in hospital. Its main emphasis was to unite professional support in the fields of physical treatment, psychological support, and support for carers and spiritual care. “There is no reason to be suspicious when the LCP is being used in appropriate circumstances to a higher standard of care,” said Dr Walker.

However, the scheme has now been rolled out across the country, with the application depending on widely differing levels of ethical application. “If it is used out of context, then it could be used to the detriment of patients e.g. a patient comes into a resuscitation bay and it is not always clear if a condition is acute and can be treated,” said Dr Walker, who recalls that in some hospitals the LCP has become known as the Lazarus Care Pathway due to the number of people who have been put on it inappropriately, are not moribound and subsequently need to be actively treated.

A colleague of Dr Walker’s did a survey on the basis of crematorium records that found in 23 per cent of all deaths of people in one city placed put on the LCP there had been no definite diagnosis at any stage.

Dr Walker puts many of the problems at the door of a lack of ethics in the application of what at face value is a good system for the terminally ill. It is the application that lacks sensitivity and can often just amount to following protocols. “The problems come when an idol is made of the protocols. It is the same story with anything if you make an idol of it you lose common sense and critical faculties,” said Dr Walker, who defines the slavish following of protocols as “tick box itus.”

She is worried that younger health professionals will be concerned about straying from the protocols for fear they might offend superiors, this means they don’t develop the acumen required to do the job. “Sometimes, in addition to what is required by a protocol, which tends to assess for a single condition, you have to follow an instinct that there is something else wrong with a patient and there is nothing wrong with that. This is the art as well as the science of clinical practice,” said Dr Walker, who abhors the way that cases like that of the murderous doctor Harold Shipman have been used to tarnish the healthcare professions …...and undermine the effectiveness of the full range of those acting as advocates for patients.

Since the membership of CMA opened to all healthcare professionals and health managers some 18 months ago, an increasing number of both those directly involved in clinical care and those in administrative roles report overt bullying in favour of targets to the exclusion of good standards of care.

Dr Walker considers the test for any healthcare professional should be that the level of care being provided matches that which they would expect for one of their own family.